Provider Demographics
NPI:1851627699
Name:M IS FOR MASSAGE, PLLC
Entity Type:Organization
Organization Name:M IS FOR MASSAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-819-9664
Mailing Address - Street 1:4715 S HUDSON ST.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2076
Mailing Address - Country:US
Mailing Address - Phone:206-819-9664
Mailing Address - Fax:
Practice Address - Street 1:2119 17TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4313
Practice Address - Country:US
Practice Address - Phone:206-819-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#MA60069631225700000X
WA#MA60089955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty